Background: Facing multiple disease-related stressors, individuals with congenital heart defects (CHD) have an increased risk for psychological distress. However, despite the resulting importance of psychological adjustment, there is a scarcity of research on how individuals affected deal with disease-related challenges. Especially the interplay of emotion regulation strategies and illness identity may be associated with higher well-being in individuals with CHD. Relationships between emotion regulation and illness identity have not yet been investigated in this population.

Methods: To address this gap, the current study examined the relationship between emotion regulation strategies, illness identity, and well-being in patients with CHD. We investigated a total of 437 individuals with CHD (18-83 years; 70.6 % female) regarding four facets of illness identity (enrichment, engulfment, acceptance, and rejection; Illness Identity Questionnaire; Oris et al., 2016), emotion regulation (reappraisal, acceptance, problem solving, social sharing, avoidance, rumination, and suppression; Heidelberg Form for Emotion Regulation Strategies; Izadpanah et al., 2019), and well-being (World Health Organization-Five Well-Being Index; WHO 1998).

Results: Our findings revealed that emotion regulation strategies were linked to illness identity. Patients with CHD who used reappraisal or social sharing more often to regulate their emotions tended to report that the chronic illness enriches their sense of self and enables them to grow as a person (i.e., enrichment; r = .40 for reappraisal and r = .24 for social sharing, p <.01). Moreover, being able to accept one’s emotional states was linked to lower levels of feeling invaded by the illness in all domains of life (i.e., engulfment; r = -.26, p <.01). Moreover, the emotion regulation strategies reappraisal, acceptance, problem solving, social sharing, and rumination as well as all four facets of illness identity were significantly associated with well-being in CHD. Remarkably, the effects were stronger for emotion regulation (range: r = -.16 to r = .39, p < .01) than for illness identity (range: r = -.13 to r = -.24, p < .01).         

Conclusions: These findings indicate that successful emotion regulation, especially through reappraisal and acceptance, is associated with more adaptive levels of illness identity and higher well-being in individuals with CHD. The results also reveal that the well-being of individuals affected is more strongly related to the use of emotion regulation strategies than to illness identity. Therefore, successfully regulating one’s emotions may be crucial for coping with illness-related stressors. Consequently, trainings specifically targeting the enhancement of emotion regulation abilities may help to improve psychological care and reduce the burden of illness for individuals with CHD.